Markers of hypercoagulation and von Willebrand factor in postmenopausal women with unstable coronary artery disease. Discriminatory ability regardingunstable coronary artery disease and coronary atherosclerosis using receiver operating characteristics

Objectives. Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these pat ients are unknown but may be due to increased thrombogenicity. We evaluated markers of hypercoagulation and thrombosis in women with clinical signs of unstable coronary artery disease (CAD). Methods and results. A total of 158 patients with unstable CAD and 101 cont rols were examined: 16% of the patients had normal vessels and 84% had coro nary atherosclerosis at coronary angiography. Mean plasma concentrations of von Willebrand factor antigen, soluble fibrin (SF), thrombin-antithrombin complex and D-dimer were significantly higher, whereas there was no differe nce regarding prothrombin fragment 1+2 between patients and controls. Patie nts with coronary atherosclerosis had higher mean plasma levels for most va riables compared with those with normal coronary vessels, although only sig nificantly higher for SF. D-Dimer was significantly higher in patients with normal coronary vessels compared with the control group. Although multi va riate analyses showed strong significant correlations of the haemostatic va riables to the diagnosis of unstable CAD, receiver operating characteristic s (ROC) revealed that none of the variables represented high diagnostic acc uracy in separating patients with unstable CAD. Likewise, none of the varia bles was particularly good at identifying coronary atherosclerosis. Conclusion. Our results are in favour of a hypercoagulable state in postmen opausal women with unstable CAD and coronary atherosclerosis, whereas this does not seem to be the case in patients with normal vessels. ROC revealed no variable to be particularly clinically useful in separating patients fro m controls or patients from those without coronary atherosclerosis.